A few cents on stroke prevention can save loads of $$$s in future stroke treatment costs

The US currently spends more than $51 billion a year on stroke-related healthcare.

XX

As we develop new treatments for acute stroke, particularly endovascular therapy, we have to recognize that these treatments are very expensive and the outcomes are still less than ideal. Even after maximal FDA approved treatment, almost 60% of stroke survivors are disabled and unable to work.

xx

There can be no doubt that stroke prevention is more important and cost effective than acute stroke therapy.

xx

We know that patients who have had a recent TIA or stroke are high risk for future major stroke.

xx

Here are some facts and figures that compare the costs and benefits of targeted stroke prevention vs. acute stroke interventions:

xx

Cost of targeted stroke prevention


1. Atrial fibrillation:
If you have had a recent TIA or stroke and have atrial fibrillation, taking an anticoagulant will reduce your future stroke risk.
Warfarin costs $37/yr
You have to treat 3 patients to prevent 1 stroke per 5 years (at a cost of $560)

xx

XX

x

2. Anti platelet drug:
If you have had a prior TIA or stroke, simply taking an aspirin a day will reduce your future stroke risk.
Aspirin costs $5/yr
You have to treat 50 patients to prevent 1 event per 5 years (at a cost of $1250).

x

2. Starting a cholesterol lowering agent:
If you have had a recent TIA or stroke, your LDL cholesterol is more than 100, and you take a cholesterol lowering agent, this will reduced your future stroke risk.
Simvastatin costs $40/yr
You have to treat 45 patients to prevent 1 stroke per 5 years (at a cost of $9000)

XX

XX

xx

3. Blood pressure:
If you have had a recent TIA or stroke, and you are started on a ACEI like ramipril, this will lower your future risk of stroke and MI.
Ramipril costs $75/yr
You have to treat 57 patients to prevent 1 stroke per 5 years (at a cost of $21,000)

XX

xx

4. Carotid stenosis:
If you have had a recent TIA or stroke caused by a carotid stenosis (with 70% or more narrowing), surgery (carotid endarterectomy) will lower your future stroke risk.
A carotid endarterectomy costs $15,000
You have to treat 2.5 patients to prevent 1 stroke per 5 years (at a cost of $188,000).
xx

XX
XX

Cost of acute stroke intervention


A single dose of intravenous tissue plasminogen activator (tPA) “clot buster” used to treat acute stroke costs $2500, this is equivalent to  the cost of 75000 aspirin tabs or 25000 simvastatin tabs.

xx

A single use of the Merci Retrieval device for a patient with acute stroke costs $27,000, this is equivalent to the cost of 750,000 aspirin tablets, 250,000 simvastatin tabs, 10 doses of iv tPA, or 2 carotid endarterectomies.

xx

Conclusion?

The message here is that acute stroke treatment, costs:

Loads of Money !!

However, targeted stroke prevention for high risk patients is much more cost effective, particularly if it is provided as a well organized out-patient TIA Rapid Evaluation Center.

xx

In the words of Ben Franklin, an ounce (or a few cents) of prevention is worth a pound (or loads of $$s) of cure.

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s